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Crisis psychotherapy often extends beyond the initial 60 minutes, especially when dealing with patients in acute distress or risk. In such cases, CPT Code 90840 allows mental health providers to bill for each additional 30 minutes of time-intensive psychotherapy following the initial crisis session (CPT 90839).
Accurately billing 90840 requires not only meeting strict time thresholds but also thorough documentation of the clinical complexity and continued need for urgent care. This guide guides when and how to bill CPT 90840 correctly, including usage scenarios, documentation requirements, modifiers, and tips to ensure proper reimbursement.
Code Description
CPT 90840 is billed for each additional 30 minutes of crisis psychotherapy following the first 60 minutes covered under CPT 90839. It reflects continued active management of a behavioral health emergency, requiring extended time, deeper clinical decision-making, and coordination with external supports.
This code is time-based and used only in combination with 90839 when the total session time exceeds 74 minutes.
When to Use CPT 90840: Clinical Scenarios
The need for CPT 90840 arises when a patient’s crisis extends beyond the standard session length, requiring additional therapeutic time. Below are scenarios where 90840 is applicable:
Suicide Risk with Complex Safety Planning
A patient with high suicide risk requires an extensive crisis session. After the first hour, the provider continues with detailed safety planning, family consultation, and arrangements for hospitalization.
Prolonged Psychotic Break
A patient undergoing a psychotic episode needs sustained engagement. The provider spends additional time stabilizing the patient, coordinating with psychiatric services, and managing ongoing safety concerns.
Post-Traumatic Response with Delayed De-escalation
After a traumatic trigger, a patient experiences a severe dissociative or panic episode that takes more than an hour to stabilize. The clinician provides extended support to regulate emotions and ensure short-term safety.
Violent or Aggressive Behavior
A patient exhibiting violent outbursts or threats requires long-term de-escalation, staff involvement, and potential law enforcement coordination, extending the session beyond 74 minutes.
These situations justify billing CPT 90840 as part of an extended crisis response.
Applicable Modifiers
Depending on the payer, the following modifiers may be required with 90840 (when billed alongside 90839):
- 95 for telehealth delivery
- GT for specific telehealth states or carriers
- 59 to denote separate services
- HO if the provider is a master's-level clinician
Confirm modifier requirements with each payer to ensure compliance.
Key Documentation Requirements
Extended Duration of Service
Record the total face-to-face time spent with the patient. To bill 90840, your documentation must show the session exceeded 74 minutes, with each additional 30-minute block justified.
Clinical Justification for Extension
Explain why the session had to continue beyond one hour. Describe the severity of the situation and why prolonged care was clinically necessary for stabilization or intervention.
Continued Interventions
Describe the additional interventions used after the initial hour, such as extended therapeutic techniques, further crisis planning, or care coordination. Highlight the time-intensive nature of the care.
External Coordination
If the extended session involved contacting family, psychiatric units, emergency services, or arranging admissions, document this in detail. It supports the complexity required for 90840.
Follow-Up or Disposition Plan
Outline what happened after the session concluded. Document the safety plan, any referrals made, and scheduled follow-up to demonstrate continuity of care.
Reimbursement Tips and Insights
Use the following strategies to optimize billing success for CPT 90840:
Track Time Precisely
Bill 90840 only applies when your total session time exceeds 74 minutes. Document the exact time and justify each additional 30-minute increment.
Combine Properly with 90839
90840 cannot be billed independently. It must follow a correctly billed CPT 90839 session for the exact date of service and provider.
Understand Payer Limits
Not all payers reimburse for multiple crisis increments. Check policies to avoid underpayment or denials.
Reimbursement Rates
- Private insurers may reimburse between $90 to $120 per 90840 unit
- Medicare generally pays $70 to $100, depending on the provider setting
- Telehealth sessions are often reimbursed at parity if billed with proper documentation and modifiers
Why Behavioral Health Providers Trust MindCare
MindCare provides expert mental health billing support for behavioral health practices, especially for high-risk crisis sessions that require precision and compliance. Our team of certified billing professionals ensures that every session, including extended crisis care under CPT 90840, is captured, documented, and reimbursed properly.
What sets us apart:
- Advanced tracking of session time and documentation elements
- Custom billing solutions for time-based codes like 90839 and 90840
- Knowledge of payer-specific rules, limits, and audit trends
- Support for both in-office and telehealth billing scenarios
Many MindCare clients have reported up to a 70% increase in revenue after implementing our advanced strategies for high-complexity behavioral health services. Let us handle the challenges of billing, so your team can remain focused on delivering life-saving care.
Let Mind Care Billing Help
We help mental health providers use the correct CPT codes, avoid denials, and get paid faster. If you're unsure which code to use, or tired of dealing with rejections, our team can take billing off your plate entirely.
Schedule a Free Consultation with Mind Care Billing today — and leave the coding confusion behind.
